Validation and cultural adaptation of the Brief Obsessive Compulsive Scale (BOCS) among Sri Lankan Sinhala speaking children and adolescents

Background: Epidemiological studies reveal that over 50% of adults with obsessive compulsive disorder (OCD) report that their symptoms started during childhood or adolescence, with a mean age of onset around 9 years. Lack of diagnostic tools for screening of OCD among children and adolescents in their native language, adds to the burden of already limited child and adolescence mental health services (CAMHS) in Sri Lanka.

Methods: The Brief Obsessive Compulsive Scale (BOCS) was translated into Sinhala, and cultural and semantic adaptation was conducted. Criterion validity was measured for the symptom checklist and severity scale, by administration of the translated tool to a sample of children and adolescents – the cases consisted of 50 children and adolescents aged 8-18 years, diagnosed to have OCD, who attended the CAMHS at Lady Ridgeway Hospital, Sri Lanka. Age and sex matched controls consisting of 50 healthy children and adolescents were selected from the general population.

Results: Criterion validity scores were obtained via the receiver operator curve for the severity scale, with a cut off of 0.92, which had a sensitivity and specificity of 100% and 92% respectively. The reliability measured by Cronbach’s alpha were 0.78 and 0.94 for the symptom checklist and severity scale respectively.

Conclusions: The locally validated BOCS has a high criterion validity, with an excellent reliability for diagnosing OCD in children and adolescents in Sri Lanka.